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Find video protocols related to scientific articles indexed in Pubmed.
[Management of patients with persistent pain following groin hernia repair.]
Ugeskr. Laeg.
PUBLISHED: 10-29-2014
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Persistent pain following groin hernia repair (PPGH) is seen in 2-4% of patients leading to functional and socioeconomic disability. A Danish research unit for PPHG was established in 2010 in collaboration with anaesthetists and surgeons. More than 140 patients have been examined with clinical and electrophysiological methods. Published data on 54 patients, treated with mesh removal and selective neurectomy, demonstrated that 65% patients experienced long-term reduction of pain. The PPHG unit is actively engaged in surgical and pharmacological research in order to improve treatment strategies.
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Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty.
Acta Orthop
PUBLISHED: 10-11-2014
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Background and purpose - Postoperative urinary retention (POUR) is a clinical challenge, but there is no scientific evidence for treatment principles. We describe the incidence of and predictive factors for POUR in fast-track total hip (THA) and knee arthroplasty (TKA). Patients and methods - This was a prospective observational study involving 1,062 elective fast-track THAs or TKAs, which were performed in 4 orthopedics departments between April and November 2013. Primary outcome was the incidence of POUR, defined by postoperative catheterization. Age, sex, anesthetic technique, type of arthroplasty, and preoperative international prostate symptom score (IPSS) were compared between catheterized and non-catheterized patients. Results - The incidence of POUR was 40% (range between departments: 30-55%). Median bladder volume evacuated by catheterization was 0.6 (0.1-1.9) L. Spinal anesthesia increased the risk of POUR (OR = 1.5, 95% CI: 1.02-2.3; p = 0.04) whereas age, sex, and type of arthroplasty did not. Median IPSS was 6 in non-catheterized males and 8 in catheterized males (p = 0.02), but it was 6 in the females in both groups (p = 0.4). Interpretation - The incidence of POUR in fast-track THA and TKA was 40%, with spinal anesthesia and increased IPSS in males as predictive factors. The large variation in perioperative bladder management and in bladder volumes evacuated by catheterization calls for randomized studies to define evidence-based principles for treatment of POUR in the future.
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Impact of a Fast-Track Esophagectomy Protocol on Esophageal Cancer Patient Outcomes and Hospital Charges.
Ann. Surg.
PUBLISHED: 09-23-2014
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To evaluate the effects of a fast-track esophagectomy protocol (FTEP) on esophageal cancer patients' safety, length of hospital stay (LOS), and hospital charges.
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Preoperative methylprednisolone enhances recovery after endovascular aortic repair: a randomized, double-blind, placebo-controlled clinical trial.
Ann. Surg.
PUBLISHED: 08-14-2014
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To evaluate effects of preoperative high-dose glucocorticoid on the inflammatory response and recovery after endovascular aortic aneurysm repair (EVAR).
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Differences in regional diagnostic strategies and in intended versus actual first-line treatment of patients with advanced ovarian cancer in denmark.
Int. J. Gynecol. Cancer
PUBLISHED: 08-08-2014
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Triage of patients with ovarian cancer to primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT) is challenging. In Denmark, the use of NACT has increased, but substantial differences in the use of NACT or PDS exist among centers. We aimed to characterize the differences between intended and actual first-line treatments in addition to the differences in the triage process among the centers and to evaluate the different diagnostic modalities and the clinical aspects' influence in the triage process.
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Test-retest Agreement and Reliability of Quantitative Sensory Testing 1 Year after Breast Cancer Surgery.
Clin J Pain
PUBLISHED: 08-02-2014
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Quantitative sensory testing (QST) is used to assess sensory dysfunction and nerve damage by examining psychophysical responses to controlled, graded stimuli such as mechanical- and thermal detection and pain thresholds. In the breast cancer population, 4 studies have used QST to examine persistent pain after breast cancer treatment (PPBCT), suggesting neuropathic pain being a prominent pain mechanism. However, the agreement and reliability of QST has not been described in the postsurgical breast cancer population, hindering exact interpretation of QST studies in this population. The aim of the present study was to assess test-retest properties of QST after breast cancer surgery.
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Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias: a regional cohort study.
Am. J. Surg.
PUBLISHED: 07-31-2014
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Mesh repair reduces the risk of reoperation for recurrence in patients with primary ventral hernias. However, reoperation for recurrence underestimates total recurrence (reoperation + clinical) and mesh reinforcement may induce chronic pain. This study investigated the total recurrence and risk of chronic pain in small primary ventral hernias.
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Reoperation rates for laparoscopic vs open repair of femoral hernias in Denmark: a nationwide analysis.
JAMA Surg
PUBLISHED: 07-10-2014
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In Denmark approximately 10?000 groin hernias are repaired annually, of which 2% to 4% are femoral hernias. Several methods for repair of femoral hernias are used including sutured repair and different types of mesh repair with either open or laparoscopic techniques. The use of many different approaches reflects a rather low level of evidence for the best method of repair. Randomized clinical trials are lacking. Large, prospective cohort studies are an alternative way of acquiring improved evidence regarding the best type of repair.
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Role of preoperative pain, muscle function, and activity level in discharge readiness after fast-track hip and knee arthroplasty.
Acta Orthop
PUBLISHED: 06-23-2014
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The concept of fast-track surgery has led to a decline in length of stay after total hip arthroplasty (THA) and total knee arthroplasty (TKA) to about 2-4 days. However, it has been questioned whether this is only achievable in selected patients-or in all patients. We therefore investigated the role of preoperative pain and functional characteristics in discharge readiness and actual LOS in fast-track THA and TKA.
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Neural blockade for persistent pain after breast cancer surgery.
Reg Anesth Pain Med
PUBLISHED: 06-12-2014
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Persistent pain after breast cancer surgery is predominantly a neuropathic pain syndrome affecting 25% to 60% of patients and related to injury of the intercostobrachial nerve, intercostal nerves, and other nerves in the region. Neural blockade can be useful for the identification of nerves involved in neuropathic pain syndromes or to be used as a treatment in its own right. The purpose of this review was to examine the evidence for neural blockade as a potential diagnostic tool or treatment for persistent pain after breast cancer surgery. In this systematic review, we found only 7 studies (n = 135) assessing blocks directed at 3 neural structures-stellate ganglion, paravertebral plexus, and intercostal nerves-but none focusing on the intercostobrachial nerve. The quality of the studies was low and efficacy inconclusive, suggesting a need for well-designed, high-quality studies for this common clinical problem.
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Standardising fast-track surgical nursing care in Denmark.
Br J Nurs
PUBLISHED: 05-14-2014
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Considerable variations in procedures, hospital stay and rates of recovery have been recorded within specific surgical procedures at Danish hospitals. The aim of this paper is to report on a national initiative in Denmark to improve the quality of surgical care by implementation of clinical guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN) in 2004. The unit was responsible for guideline construction and implementation using the 'workshop practice method': establishing a website, creating a knowledge centre, coordinating implementation agents, and arranging national workshops and conferences. The UPN has promoted implementation of fast-track regimes in all surgical departments in Denmark. We recommend the workshop-practice method for implementation of new procedures in other areas of patient care.
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Cognitive dysfunction after fast-track hip and knee replacement.
Anesth. Analg.
PUBLISHED: 05-01-2014
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Postoperative cognitive dysfunction (POCD) is reported to occur after major surgery in as many as 20% of patients, elderly patients may especially experience problems in the weeks and months after surgery. Recent studies vary greatly in methods of evaluation and diagnosis of POCD, and the pathogenic mechanisms are still unclear. We evaluated a large uniform cohort of elderly patients in a standardized approach, after major joint replacement surgery (total hip and knee replacement). Patients were in an optimized perioperative approach (fast track) with multimodal opioid-sparing analgesia, early mobilization, and short length of stay (LOS ?3 days) and discharged to home.
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Early progressive strength training to enhance recovery after fast-track total knee arthroplasty. A randomized controlled trial.
Arthritis Care Res (Hoboken)
PUBLISHED: 04-02-2014
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Objective. To compare 7 weeks of supervised physical rehabilitation with or without progressive strength training (PST) commenced early after fast-track total knee arthroplasty (TKA) on functional performance. Methods. Eighty-two patients with a unilateral primary TKA were randomized to 2 different interventions: 7 weeks of supervised physical rehabilitation with (PST-group) and without (CON-group) PST commenced early after fast-track TKA. The primary outcome was the maximal distance walked in 6 minutes (6-minute walk test). Secondary outcomes were lower limb strength and power, knee joint effusion and range of motion, knee pain and self-reported disability and quality of life. All outcome measures were assessed before (baseline) and 4, 8 and 26 weeks after TKA. Results. There was no statistically significant difference between the PST- and CON-group in the change score from baseline to the 8-week postoperative assessment (primary endpoint) for the 6-minute walk test with unadjusted baseline scores (mean difference between groups: -11.3 meters, 95% confidence interval -45.4 to 22.7 meters; analysis of variance (ANOVA), p=0.51). There were no statistically significant or clinically meaningful differences between groups in change scores from baseline to any other time point for all secondary outcomes. The secondary outcome, knee-extension strength did not reach the level recorded before surgery in both groups. Conclusions. Seven weeks of supervised physical rehabilitation with PST was not superior to 7 weeks of supervised physical rehabilitation without PST in improving functional performance, measured as the maximal walking distance in 6 minutes, at the primary endpoint 8 weeks after fast-track TKA. © 2014 American College of Rheumatology.
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Procedure-specific pain management and outcome strategies.
Best Pract Res Clin Anaesthesiol
PUBLISHED: 03-28-2014
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Optimal dynamic pain relief is a prerequisite for optimizing post-operative recovery and reducing morbidity and convalescence. Procedure-specific pain management initiative aims to overcome the limitations of conventional guidelines and provide health-care professionals with practical recommendations formulated in a way that facilitates clinical decision making across all the stages of the perioperative period. The procedure-specific evidence is supplemented with data from other similar surgical procedures and clinical practices to balance benefits and risks of each analgesic technique. There is emphasis on the use of multimodal analgesia and preventive analgesia aimed at reducing central sensitization. Importantly, the benefits of dynamic pain relief may only be realized if other aspects of perioperative care such as the use of minimally invasive surgery, approaches to reduce stress responses, optimizing fluid therapy and optimizing post-operative nursing care with early mobilization and oral feeding are utilized.
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Postoperative sleep disturbances after zolpidem treatment in fast-track hip and knee replacement.
J Clin Sleep Med
PUBLISHED: 03-18-2014
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Previous studies have demonstrated pronounced reduction of REM sleep on the first nights following major surgery which may influence pain, analgesic use, and recovery. This placebo-controlled, randomized, double-blind study set out to evaluate the effect of zolpidem on sleep architecture in an elderly population undergoing fast-track total hip and knee arthroplasty (THA/TKA) with length of stay < 3 days.
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Effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy: a randomized, placebo-controlled trial.
Acta Obstet Gynecol Scand
PUBLISHED: 03-01-2014
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To assess the effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy, and describe the technique in detail.
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Early morbidity after simultaneous and staged bilateral total knee arthroplasty.
Knee Surg Sports Traumatol Arthrosc
PUBLISHED: 01-24-2014
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The aim of this nationwide study was to investigate the early morbidity after bilateral simultaneous and staged total knee arthroplasty (TKA) in order to clarify potential benefits of a well-established fast-track regime.
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Feasibility of progressive strength training implemented in the acute ward after hip fracture surgery.
PLoS ONE
PUBLISHED: 01-01-2014
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Patients with a hip fracture lose more than 50% knee-extension strength in the fractured limb within one week of surgery. Hence, immediate progressive strength training following hip fracture surgery may be rational, but the feasibility unknown.
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Knee pain during strength training shortly following fast-track total knee arthroplasty: a cross-sectional study.
PLoS ONE
PUBLISHED: 01-01-2014
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Loading and contraction failure (muscular exhaustion) are strength training variables known to influence neural activation of the exercising muscle in healthy subjects, which may help reduce neural inhibition of the quadriceps muscle following total knee arthroplasty (TKA). It is unknown how these exercise variables influence knee pain after TKA.
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Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study.
BMJ Open
PUBLISHED: 12-17-2013
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International guidelines recommend thrombosis prophylaxis after total hip arthroplasty (THA) and total knee arthroplasty (TKA) for up to 35 days. However, previous studies often have hospital stays (length of stay; LOS) of 8-12 days and not considering early mobilisation, which may reduce incidence of venous thromboembolic events (VTE). We investigated the incidence of any symptomatic thromboembolic events (TEEs) with only in-hospital prophylaxis if LOS ?5 days after fast-track THA and TKA.
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Risk of morbidity, mortality, and recurrence after parastomal hernia repair: a nationwide study.
Dis. Colon Rectum
PUBLISHED: 10-10-2013
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Surgical outcome results after repair for parastomal hernia are sparsely reported and based on small-scale studies.
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High agreement between the Danish ventral hernia database and hospital files.
Dan Med J
PUBLISHED: 10-03-2013
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Ventral hernia repairs are common surgical procedures and quality monitoring with a high validity is mandatory. The aim of the present study was to validate the data quality of the Danish Ventral Hernia Database (DVHD).
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Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients? A nationwide Danish study.
Gynecol. Oncol.
PUBLISHED: 09-11-2013
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In Denmark, the proportion of women with ovarian cancer treated with neoadjuvant chemotherapy (NACT) has increased, and the use of NACT varies among center hospitals. We aimed to evaluate the impact of first-line treatment on surgical outcome and median overall survival (MOS).
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Lidocaine Patch (5%) in Treatment of Persistent Inguinal Postherniorrhaphy Pain: A Randomized, Double-blind, Placebo-controlled, Crossover Trial.
Anesthesiology
PUBLISHED: 07-27-2013
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Evidence-based pharmacological treatment options for patients with persistent inguinal postherniorrhaphy pain are lacking.
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Fast-track knee arthroplasty -- status and future challenges.
Knee
PUBLISHED: 07-08-2013
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Fast-track programs have been developed for different surgical procedures leading to higher patient satisfaction and lower morbidity. This concept has been extended to knee arthroplasty in recent years. The purpose of this narrative review was to discuss the different aspects of fast-track knee arthroplasty.
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Outcomes after emergency versus elective ventral hernia repair: a prospective nationwide study.
World J Surg
PUBLISHED: 06-13-2013
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Early surgical results after emergency repairs for the most frequent ventral hernias (epigastric, umbilical, and incisional) are not well described. Thus, the aim of present study was to investigate early results and risk factors for poor 30-day outcome after emergency versus elective repair for ventral hernias.
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Does goal-directed fluid therapy affect postoperative orthostatic intolerance?: A randomized trial.
Anesthesiology
PUBLISHED: 06-13-2013
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Early mobilization is important for postoperative recovery but is limited by orthostatic intolerance (OI) with a prevalence of 50% 6 h after major surgery. The pathophysiology of postoperative OI is assumed to include hypovolemia besides dysregulation of vasomotor tone. Stroke volume-guided fluid therapy, so-called goal-directed therapy (GDT), corrects functional hypovolemia, and the authors hypothesized that GDT reduces the prevalence of OI after major surgery and assessed this in a prospective, double-blinded trial.
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Prediction of postoperative pain by preoperative pain response to heat stimulation in total knee arthroplasty.
Pain
PUBLISHED: 06-05-2013
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It has been estimated that up to 54% of the variance in postoperative pain experience may be predicted with preoperative pain responses to experimental stimuli, with suprathreshold heat pain as the most consistent test modality. This study aimed to explore whether 2 heat test paradigms could predict postoperative pain after total knee arthroplasty (TKA). Patients scheduled for elective, unilateral, primary TKA under spinal anesthesia were consecutively included in this prospective, observational study. Perioperative analgesia was standardized for all patients. Outcomes were postoperative pain during walk: from 6 to 24 hours (primary), from postoperative day (POD) 1 to 7 (secondary), and from POD 14 to 30 (tertiary). Two preoperative tonic heat stimuli with 47°C were used; short (5 seconds) and long (7 minutes) stimulation upon which patients rated their pain response on an electronic visual analog scale. Multivariate stepwise linear and logistic regressions analyses were carried out, including 8 potential preoperative explanatory variables (among these anxiety, depression, preoperative pain, and pain catastrophizing) to assess pain response to preoperative heat pain stimulation as an independent predictor for postoperative pain. A total of 100 patients were included, and 3 were later excluded. A weak correlation [rho (95% confidence interval); P value] was observed between pain from POD 1 to 7 and pain response to short [rho=0.25(0.04 to 0.44); P=.02] and to long [rho=0.27 (0.07 to 0.46); P=.01] heat pain stimulation. However, these positive correlations were not supported by the linear and logistic regression analyses, in which only anxiety, preoperative pain, and pain catastrophizing were significant explanatory variables (but with low R-squares; 0.05 to 0.08). Pain responses to 2 types of preoperative heat stimuli were not independent clinically relevant predictors for postoperative pain after TKA.
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Fast-track surgery for breast cancer is possible.
Dan Med J
PUBLISHED: 05-16-2013
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Breast cancer is common among Danish women with more than 4,100 new cases annually. In 2008 the concept of fast-track surgery was introduced at the Department of Breast Surgery at Rigshospitalet, Copenhagen. The aim of this study is to describe the new clinical pathway for breast cancer patients after implementation of a fast-track surgery programme.
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A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery.
Eur Spine J
PUBLISHED: 05-07-2013
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Major spine surgery with multilevel instrumentation is followed by large amount of opioid consumption, significant pain and difficult mobilization in a population of predominantly chronic pain patients. This case-control study investigated if a standardized comprehensive pain and postoperative nausea and vomiting (PONV) treatment protocol would improve pain treatment in this population.
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Persistent pain and sensory disturbances after treatment for breast cancer: six year nationwide follow-up study.
BMJ
PUBLISHED: 04-13-2013
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To examine the development of persistent pain after treatment for breast cancer and to examine risk factors associated with continuing pain.
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Role of preoperative anemia for risk of transfusion and postoperative morbidity in fast-track hip and knee arthroplasty.
Transfusion
PUBLISHED: 04-11-2013
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Preoperative anemia has been associated with increased risk of allogeneic blood transfusion and postoperative morbidity and mortality. The prevalence of preoperative anemia and its association with postoperative outcomes has not previously been reported in relation to fast-track elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). We aimed to evaluate the prevalence of preoperative anemia in elective fast-track THA and TKA and its association with risk of perioperative transfusion, prolonged length of hospital stay (LOS), and postoperative readmission.
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Acute hospitalization of the older patient: changes in muscle strength and functional performance during hospitalization and 30 days after discharge.
Am J Phys Med Rehabil
PUBLISHED: 04-05-2013
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Acute hospitalization of older patients may be associated with loss of muscle strength and functional performance. The aim of this study was to investigate the effect of acute hospitalization as a result of medical disease on muscle strength and functional performance in older medical patients.
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Persistent postmastectomy pain in breast cancer survivors: analysis of clinical, demographic, and psychosocial factors.
J Pain
PUBLISHED: 03-06-2013
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Persistent postmastectomy pain (PPMP) is increasingly recognized as a major individual and public health problem. Although previous studies have investigated surgical, medical, and demographic risk factors, in this study we aimed to more clearly elucidate the relationship of psychosocial factors to PPMP. Postmastectomy patients (611) were queried about pain location, severity, and burden 38.3 ± 35.4 months postoperatively. Validated questionnaires for depressive symptoms, anxiety, sleep, perceived stress, emotional stability, somatization, and catastrophizing were administered. Detailed surgical, medical, and treatment information was abstracted from patients medical records. One third (32.5%) of patients reported PPMP, defined as ?3/10 pain severity in the breast, axilla, side, or arm, which did not vary according to time since surgery. Multiple regression analysis revealed significant and independent associations between PPMP and psychosocial factors, including catastrophizing, somatization, anxiety, and sleep disturbance. Conversely, treatment-related factors including surgical type, axillary node dissection, surgical complication, recurrence, tumor size, radiation, and chemotherapy were not significantly associated with PPMP. These data confirm previous studies suggesting that PPMP is relatively common and provide new evidence of significant associations between psychosocial characteristics such as catastrophizing with PPMP, regardless of the surgical and medical treatment that patients receive, which may lead to novel strategies in PPMP prevention and treatment.
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Simultaneous and staged bilateral total hip arthroplasty: a Danish nationwide study.
Arch Orthop Trauma Surg
PUBLISHED: 02-19-2013
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Bilateral total hip arthroplasty (BTHA) and bilateral simultaneous total hip arthroplasty (BSTHA) are done increasingly. Previous studies evaluating outcomes after bilateral procedures have found different results. The aim of this study was to investigate length of hospital stay (LOS), 30 days readmissions and 90 days mortality after BSTHA and BTHA on a nationwide basis.
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Pain-related impairment of daily activities after thoracic surgery: a questionnaire validation.
Clin J Pain
PUBLISHED: 02-02-2013
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Persistent postoperative pain is an acknowledged entity that reduces daily activities. Evaluation of the post-thoracotomy pain syndrome (PTPS) is often measured using traditional pain scales without in-depth questions on pain impairment. Thus, the purpose was to create a procedure-specific questionnaire for assessment of functional impairment due to PTPS.
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No effect of fibrin sealant on drain output or functional recovery following simultaneous bilateral total knee arthroplasty: a randomized, double-blind, placebo-controlled study.
Acta Orthop
PUBLISHED: 01-25-2013
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Blood loss after total knee arthroplasty (TKA) may lead to anemia, blood transfusions, and increased total costs. Also, bleeding into the periarticular tissue may cause swelling and a reduction in quadriceps strength, thus impairing early functional recovery. In this randomized, double-blind, placebo-controlled study, we analyzed the possible effect of fibrin sealant on blood loss and early functional recovery in a fast-track setting.
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Activity, sleep and cognition after fast-track hip or knee arthroplasty.
J Arthroplasty
PUBLISHED: 01-24-2013
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Optimized perioperative care after total hip and knee arthroplasty (THA/TKA) has decreased length of stay (LOS) but data on activity, sleep and cognition after discharge are limited. We included 20 patients ? 60 years undergoing THA/TKA, monitoring them for 3 days preoperatively and 9 days postoperatively with actigraphs for sleep and activity assessment. Pain scores were recorded daily. Cognition was evaluated by 2 cognitive tests. Results showed a mean age was 70.5 years and mean LOS was 2.6 days. Actigraphs showed increased daytime sleep and decreased motor activity postoperatively. Early postoperatively cognitive decline and increased pain returned to preoperative levels by postoperative day (POD) 5-9. Despite the small sample size the study illustrated that post-discharge activity is decreased and daytime sleep is increased after fast-track THA/TKA, while cognition and pain return to preoperative levels by POD 9. Objective assessment of these recovery parameters may be valuable in future interventional studies to enhance recovery after THA/TKA.
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Quantitative sensory testing in patients with postthoracotomy pain syndrome: Part 2: variability in thermal threshold assessments.
Clin J Pain
PUBLISHED: 01-19-2013
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Quantitative sensory testing is a reference method for characterization of postsurgical neuropathic components. Correct interpretation of data requires detailed information concerning the validity of the testing methods. The objective of the study was to assess the test-retest variability of thermal thresholds in patients (n = 14) with the postthoracotomy pain syndrome.
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Sensory testing in patients with postthoracotomy pain syndrome: Part 1: mirror-image sensory dysfunction.
Clin J Pain
PUBLISHED: 01-19-2013
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Mirror-image sensory dysfunction (MISD) has not been systematically characterized in persistent postoperative pain.
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Fall-related admissions after fast-track total hip and knee arthroplasty - cause of concern or consequence of success?
Clin Interv Aging
PUBLISHED: 01-01-2013
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Total hip (THA) and knee arthroplasty (TKA) are common procedures in elderly persons, who are at potential increased risk of postoperative fall due to loss of muscle strength and impaired balance. Fast-track surgery with early mobilization and opioid-sparing analgesia have improved outcomes after these procedures, but early mobilization and short hospitalization length of stay (LOS) could potentially increase the risk of falls after discharge. We investigated injuries, circumstances, and the timing of fall-related hospital admissions 90 days after fasttrack THA and TKA.
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Surgery-induced changes and early recovery of hip-muscle strength, leg-press power, and functional performance after fast-track total hip arthroplasty: a prospective cohort study.
PLoS ONE
PUBLISHED: 01-01-2013
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By measuring very early changes in muscle strength and functional performance after fast-track total hip arthroplasty (THA), post-operative rehabilitation, introduced soon after surgery, can be designed to specifically target identified deficits.
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Multimodal analgesic treatment in video-assisted thoracic surgery lobectomy using an intraoperative intercostal catheter.
Eur J Cardiothorac Surg
PUBLISHED: 12-21-2011
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No golden standard for analgesia in video-assisted thoracic surgery (VATS) lobectomy exists. A simple multimodal approach using an intercostal catheter (ICC) may be of benefit since acute post-operative pain following VATS lobectomy primarily originates from the chest drain area.
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Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible?
Disabil Rehabil
PUBLISHED: 11-15-2011
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To explore the feasibility of progressive strength training commenced immediately after total knee arthroplasty (TKA).
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Why still in hospital after fast-track hip and knee arthroplasty?
Acta Orthop
PUBLISHED: 11-09-2011
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Length of stay (LOS) following total hip and knee arthroplasty (THA and TKA) has been reduced to about 3 days in fast-track setups with functional discharge criteria. Earlier studies have identified patient characteristics predicting LOS, but little is known about specific reasons for being hospitalized following fast-track THA and TKA.
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Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways.
Reg Anesth Pain Med
PUBLISHED: 10-18-2011
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Fast-track programs have been developed with the aim to reduce perioperative surgical stress and facilitate patients recovery after surgery. Potentially, regional anesthesia and analgesia techniques may offer physiological advantages to support fast-track methodologies in different type of surgeries. The aim of this article was to identify and discuss potential advantages offerred by regional anesthesia and analgesia techniques to fast-track programs.In the first section, the impact of regional anesthesia on the main elements of fast-track surgery is addressed. In the second section, procedure-specific fast-track programs for colorectal, hernia, esophageal, cardiac, vascular, and orthopedic surgeries are presented. For each, regional anesthesia and analgesia techniques more frequently used are discussed. Furthermore, clinical studies, which included regional techniques as elements of fast-track methodologies, were identified. The impact of epidural and paravertebral blockade, spinal analgesia, peripheral nerve blocks, and new regional anesthesia techniques on main procedure-specific postoperative outcomes is discussed. Finally, in the last section, implementations required to improve the role of regional anesthesia in the context of fast-track programs are suggested, and issues not yet addressed are presented.
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Nationwide analysis of prolonged hospital stay and readmission after elective ventral hernia repair.
Dan Med Bull
PUBLISHED: 10-07-2011
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Early outcome after elective ventral hernia repair is unsatisfactory, but detailed analyses are lacking. The aim of this study was to describe the aetiology of prolonged hospital stay (LOS), readmission and death < 30 days after elective ventral hernia repair.
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[Early post-operative mobilization and orthostatic intolerance].
Ugeskr. Laeg.
PUBLISHED: 09-07-2011
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Early mobilization after surgery is crucial for an enhanced recovery and can reduce complications associated with immobility. Symptoms such as nausea, vomiting, blurred vision and dizziness are however known to impede early mobilization. Together these symptoms comprise orthostatic intolerance (OI), in which the ultimate manifestation is syncope. In reference to find preventive and relevant treatment for OI studies with a multimodal approach have shown promising results, though the pathophysiology behind OI is not fully understood.
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Local infiltration analgesia in urogenital prolapse surgery: a prospective randomized, double-blind, placebo-controlled study.
Acta Obstet Gynecol Scand
PUBLISHED: 08-29-2011
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To evaluate the analgesic effect of high-volume infiltration analgesia in urogenital prolapse surgery and provide a detailed description of the infiltration technique.
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High-volume infiltration analgesia in bilateral hip arthroplasty. A randomized, double-blind placebo-controlled trial.
Acta Orthop
PUBLISHED: 07-13-2011
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High-volume infiltration analgesia may be effective in postoperative pain management after hip arthroplasty but methodological problems prevent exact interpretation of previous studies.
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Prolonged length of stay and many readmissions after appendectomy.
Dan Med Bull
PUBLISHED: 07-05-2011
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The epidemiology of appendicitis seems to be changing; the proportion of complicated appendicitis cases is growing. The outcome of childhood appendectomy in Denmark has not previously been evaluated nationwide in Denmark.
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[Undocumented regimes after total hip and knee arthroplasty can deteriorate the results].
Ugeskr. Laeg.
PUBLISHED: 06-22-2011
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Undocumented traditions in perioperative care after total hip and knee arthroplasty are passed on as gold standard. However, evidence-based medicine may interfere with traditions. It is therefore essential to revisit traditions or routines once in a while and re-evaluate current practice according to existing evidence. Fast track surgery is an example of replacing traditions with evidence-based clinical features in order to optimise perioperative outcome. This article reviews some traditions that may influence outcome regarding pain, infection, blood loss, mobilisation, length of stay in hospital, thromboembolic prophylaxis, and costs.
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Intraoperative local infiltration analgesia for early analgesia after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial.
Reg Anesth Pain Med
PUBLISHED: 05-26-2011
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High-volume local infiltration analgesia (LIA) is widely applied as part of a multimodal pain management strategy in total hip arthroplasty (THA). However, methodological problems hinder the exact interpretation of previous trials, and the evidence for LIA in THA remains to be clarified. Therefore, we evaluated whether intraoperative high-volume LIA, in addition to a multimodal oral analgesic regimen, would further reduce acute postoperative pain after THA.
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Fast-track revision knee arthroplasty. A feasibility study.
Acta Orthop
PUBLISHED: 05-11-2011
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Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery.
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Aetiology, treatment and mortality after oesophageal perforation in Denmark.
Dan Med Bull
PUBLISHED: 05-04-2011
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Perforation of the oesophagus into the thoracic cavity is a potentially life-threatening condition. The causes are numerous. Treatment for oesophageal perforation targets mediastinal and pleural contamination. Present knowledge about the causes of perforation and the types of treatment is poor.
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Persistent pain after targeted intraoperative radiotherapy (TARGIT) or external breast radiotherapy for breast cancer: a randomized trial.
Breast
PUBLISHED: 04-30-2011
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Persistent pain after breast cancer treatment (PPBCT) affects between 25 and 60% of patients depending on surgical and adjuvant treatment. External breast radiotherapy (EBRT) has been shown to be a riskfactor for PPBCT, raising the question whether intraoperative radiation therapy (IORT), with its smaller radiation field may reduce the development of PPBCT. Using data from the TARGIT-A trial, the aim of this study was to compare these two treatments with regard to development of PPBCT. A total of 281 patients enrolled in the TARGIT-A trial from the Copenhagen University Hospitals was screened for participation, and a total of 244 patients were included and received a detailed questionnaire. The response rate was 98%, leaving 238 patients for the final analysis. Pain prevalence were 33.9% in the EBRT group and 24.6% in the IORT group (p = 0.11). Treatment with IORT may not alter the risk of PPBCT.
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Low risk of trocar site hernia repair 12 years after primary laparoscopic surgery.
Surg Endosc
PUBLISHED: 04-28-2011
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The risk of trocar site hernia (TSH) may be 0-22%, but no large scaled data with long-term follow-up are available. The purpose of this study was to estimate the long-term risk of TSH repair.
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Preventive analgesia.
Curr Opin Anaesthesiol
PUBLISHED: 04-12-2011
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This paper will discuss the concepts of pre-emptive and preventive analgesia in acute and persistent postsurgical pain, based on the most recent experimental and clinical literature, with a special focus on injury-induced central sensitization and the development from acute to chronic pain.
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Bilateral simultaneous total hip arthroplasty in a fast track setting.
Hip Int
PUBLISHED: 04-07-2011
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Abstract: Simultaneous bilateral hip arthroplasty has been reported to have varying results in the literature when performed using conventional postoperative care. Unilateral hip and knee arthroplasty as well as bilateral simultaneous knee arthroplasty may be associated with reduced length of stay and low complication rates when performed in a fast-track setting. We believed it would be useful to assess hip arthroplasty in this context, and we report 50 consecutive fast-track simultaneous bilateral hip arthroplasty procedures. The median length of stay was 4 days. Mortality within 90 days was 4% and 8% required a further operative procedure. The overall complication rate was 22%. 55% of the complications were considered to be caused by failures in surgical technique and 45% by other factors. Bilateral simultaneous hip arthroplasty may have a high complication rate in a fast-track setting and further evaluation may be warranted.
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Phantom breast sensations are frequent after mastectomy.
Dan Med Bull
PUBLISHED: 04-07-2011
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Phantom breast sensation (PBS) following mastectomy has been recognized for many years. PBS is a feeling that the removed breast is still there. The reported prevalence and risk factors have not been established in large well-defined patient series. The purpose of this study was to examine the prevalence of PBS following mastectomy and associated risk factors.
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Effect of transcutaneous electrical muscle stimulation on muscle volume in patients with septic shock.
Crit. Care Med.
PUBLISHED: 04-07-2011
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Intensive care unit admission is associated with muscle wasting and impaired physical function. We investigated the effect of early transcutaneous electrical muscle stimulation on quadriceps muscle volume in patients with septic shock.
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Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice.
Acta Anaesthesiol Scand
PUBLISHED: 04-04-2011
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Relief of acute pain after hip and knee replacement represents a major therapeutic challenge as post-operative pain hinders early mobilisation and rehabilitation with subsequent consequences on mobility, duration of hospitalisation and overall recovery. In recent years, there has been increased interest in high-volume local wound infiltration/infusion techniques in these operations with a combined administration of local anaesthetics, NSAIDs and epinephrine. This review provides an update of the current knowledge of the efficacy of the high-volume wound infiltration technique based on randomised trials. It is concluded that a predominant part of the data have had an insufficient design by not being placebo-controlled or with comparable systemic analgesia provided in the investigated groups. It is concluded that there is little evidence to support the use of the technique in hip replacement either intraoperatively or with a post-operative wound infusion catheter technique, provided that multimodal, oral non-opioid analgesia is given. In knee replacement, the data support the intraoperative use of the local infiltration technique but not the post-operative use of wound catheter administration. In knee replacement, a compression bandage prolongs the analgesic effect. There are limited data to support the use of NSAIDs or epinephrine in the solution and the data on post-operative hospitalisation and recovery are conflicting. Thus, shorter lengths of stay have been achieved by oral multimodal, non-opioid analgesia together with organisational optimisation of care according to the fast-track methodology.
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Reduced length of stay following hip and knee arthroplasty in Denmark 2000-2009: from research to implementation.
Arch Orthop Trauma Surg
PUBLISHED: 03-24-2011
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Fast-track surgery is the combination of optimized clinical and organizational factors aiming at reducing convalescence and perioperative morbidity including the functional recovery resulting in reduced hospitalization. As the previous nationwide studies have demonstrated substantial variations in length of stay (LOS) following standardized operations such as total hip and knee arthroplasty (THA and TKA), this nationwide study was undertaken to evaluate the implementation process of fast-track THA and TKA in Denmark.
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Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention.
J Pain
PUBLISHED: 03-24-2011
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Chronic pain after breast cancer treatment is a major clinical problem, affecting 25 to 60% of patients. Development of chronic pain after breast cancer treatment, as well as other surgical procedures, involves a complex pathophysiology that involves pre-, intra- and post-operative factors. This review is a systematic analysis on methodology and evidence in research into persistent pain after breast cancer treatment during the period 1995 to 2010, in order to clarify the significance and relative role of potential risk factors. Literature was identified by a search in PubMed and OVID, as well as by obtaining relevant studies from a systematic review of reference lists. Sixty papers were identified, most of these being retrospective or questionnaires. Only 2 studies included quantitative sensory testing and only 26 studies were prospective. Furthermore, about a third of the studies did not apply modern principles of surgical and adjuvant therapy. In summary, the data show inconsistencies in definition of chronic pain and treatment groups, as well as in the collection of pre- intra- and post-operative data, precluding conclusions with regard to pathophysiologic mechanisms as well as rational strategies for prevention and treatment. However, nerve damage and radiotherapy appear to be significant risk factors for chronic pain. A proposal for the design of future prospective studies is presented.
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[Blood transfusion in major orthopaedic surgery].
Ugeskr. Laeg.
PUBLISHED: 03-16-2011
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Hip and knee surgery is associated with a relatively large bleeding and a need for perioperative transfusion. Postoperative anaemia may delay recovery, but transfusion carries inherent risks. However, only few randomised controlled studies evaluating the effects of different transfusion triggers have been performed in orthopaedic surgery. The majority of these studies suffer from methodological weaknesses and have not been performed in a fast-track setting. Thus, large randomised studies evaluating a restrictive versus a liberal transfusion strategy in a procedure-specific setup are needed.
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[Rehabilitation after breast cancer surgery].
Ugeskr. Laeg.
PUBLISHED: 03-16-2011
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The short- and long-term benefits of post-discharge physiotherapy regimens after breast cancer surgery are debatable. A national survey in Denmark performed at hospitals and municipal rehabilitation clinics showed considerable variability in post-breast surgery rehabilitation regimens. As hospital stay duration has decreased substantially, the need for post-discharge physiotherapy may also have changed. Thus, the indication for and type of rehabilitation programmes need to be evaluated.
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Psychological distress among women with newly diagnosed breast cancer.
Eur J Oncol Nurs
PUBLISHED: 03-15-2011
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Psychological distress is common in the cancer continuum. Our objectives were to determine the prevalence of distress and to investigate the related problems and the characteristics of women with breast cancer who experienced psychological distress at the time of diagnosis.
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Thigh and knee circumference, knee-extension strength, and functional performance after fast-track total hip arthroplasty.
PM R
PUBLISHED: 02-22-2011
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To (1) quantify changes in knee-extension strength and functional-performance at discharge after fast-track total hip arthroplasty (THA) and (2) investigate whether these changes correlate to changes in thigh and knee circumference (ie, swelling) or pain.
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.